Transgender kids: How young is too young for a sex change?

Delving into the often tumultuous worlds of transgender youth

ON HER THIRD birthday, Sarah Barnett tore open a package from her grandmother that would delight most girls her age. Gently folded on a pillow of tissue paper lay a frilly, ruffled dress. Sarah looked up at her mother, Kathy, perplexed.

"Mom, why did Grandma give me a dress?" she asked.

A perfectly reasonable question, since Sarah had refused to wear girls' clothing as soon as she knew the difference. Kathy explained that Grandma was just trying to be nice—Sarah didn't have to wear the dress.

Rachel Salomon

Nick Vlcek

Walter Bockting, president-elect of the World Professional Association for Transgender Health

"Why don't you tell Grandma that I'm a boy?" Sarah asked.

Kathy marveled at her child's logic. The mother chalked the child's comment up to the imaginative reasoning of a toddler.

A few weeks later, Sarah asked her Sunday school teacher to label her nametag "Steven." Soon, she was insisting that her parents call her Steven and refer to her as "he." Kathy and her husband, Joe (names have been changed), gently explained to their daughter that she was a girl, not a boy. But the toddler became so upset that they eventually conceded to calling her Steven at home.

Her behavior and tastes, too, were more like those of a stereotypical boy. She preferred active, rough-and-tumble play. At Christmas, she'd gaze forlornly at dolls she received, clearly preferring her older brother's train sets. At the pool, she insisted on wearing swim trunks instead of a one-piece girl's bathing suit. At age four, Sarah gave all her dresses away to a neighbor girl. She wanted a little suit—like Daddy's.

Kathy had gone to college during the early feminist movement, and believed that gender was a social construct. What was she doing wrong that her fabulous little girl seemed to think it was better to be a boy?

Kathy consulted a therapist, who told her not to worry, the phase would pass. Another therapist said Sarah would probably grow up to be lesbian. That didn't seem like the right diagnosis to Kathy. Still, the mother pulled her children along in a little red wagon at the Twin Cities' gay pride parades, wanting to show them all the different ways to be a woman.

By first grade, Sarah's insistence that she was a boy had grown so intense—and her distress at being called a girl so great—that Kathy sent her daughter to a new school and persuaded the teacher to call her child Steven. The other children, though, peppered Steven with questions. "Are you a boy or a girl?" they'd ask. One morning, the principal pulled Steven out of class and took him outside for a walk.

"Would you like the questions to stop?" she asked.

"Yes," Steven told her, feeling scared.

The principal explained that she planned to hold a school-wide assembly the next day. The topic: telling everyone once and for all that Steven was a girl.

The child looked up at her, horrified.

"Why don't you tell them I'm a boy?"

WALTER BOCKTING crosses one gray wool pants-clad leg over the other and leans forward in his chair in his office at the Center for Sexual Health at the University of Minnesota. Bockting is president-elect of the World Professional Association for Transgender Health, the group that sets standards of care for people with gender identity disorders. His bright blue eyes emanate an intense kindness that suggests if you tell him all your secrets, he'll understand.

In his clinical practice, Bockting works with children and adults who are uncomfortable with their physical sex. About eight years ago, he noticed an uptick in the number of children and adolescents coming to him—kids now make up about 20 percent of his clientele. Helping an adult is more straightforward, he says. Children present a special challenge.

"Gender identity is set by age 2.5," Bockting explains. "Yet you cannot ask a three-year-old, 'What's your gender identity?'"

The term "gender identity" refers to an individual's innate sense of gender, regardless of physical sex characteristics. It first came into use in the 1960s, through the work of John Money, the Johns Hopkins University psychologist famous for his role in the case of "John/Joan"—a male child surgically altered to live as a girl after a botched circumcision. Money theorized that gender identity is fluid at birth, but consolidates at a young age.

In 1980, the term "gender identity disorder" debuted in the Diagnostic and Statistical Manual of Mental Disorders, the psychologist's bible. Since then, the definition has been revised and become increasingly controversial. Now, mere mention of the term can set off activists, who say that like homosexuality, gender variance, as they prefer to call it, is simply a variation within the human range of normal.

So far, researchers haven't found a biological silver bullet to explain why some people's gender identities don't match their bodies. For Bockting, the real question is how to help kids who suffer from the condition. Most children grow out of gender identity disorder by their teens. As adults, many are gay, some are heterosexual, but only a few become transsexuals. Because the diagnosis usually goes away, psychologists rarely recommend that a child with gender identity disorder live as the other sex. But in some cases, when young children are extremely depressed, even suicidal, an early switch may be the best option, Bockting says.

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I have no problem with a teenager exploring GII, but I've read about children who are TOO young whose parents are okay with it. I agree with Walter, these things are a BIG decision, and in all honesty, they're too young to make a decision like that. You're never sure if it is a phase or not, and in some cases, it may be.